Improved Outcomes Using a Systematic and Evidence-Based Approach to the Laparoscopic Roux-En-Y Gastric Bypass in a Single Academic Institution

2007 ◽  
Vol 73 (10) ◽  
pp. 955-958 ◽  
Author(s):  
Soo Hwa Han ◽  
Carlos Gracia ◽  
Amir Mehran ◽  
Nicole Basa ◽  
Joe Hines ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Average Length ◽  
Anastomotic Stricture ◽  
Preoperative Evaluation ◽  
Length Of Hospital Stay ◽  
Marginal Ulcer ◽  
Ulcer Bleeding ◽  
Evidence Based ◽  
Improved Outcomes

No standardized approach exists for laparoscopic Roux-en-Y gastric bypass (LRYGB). At a newly instituted bariatric surgery program, four experienced laparoscopic surgeons used the systematic and evidence-based approach consisting of multidisciplinary preoperative evaluation, screening, and education; standardized operative technique; inpatient clinical pathway; and close postoperative follow-up. The outcomes were subsequently analyzed to determine if this approach improved the morbidity and mortality. From January 2003 to June 2006, 835 consecutive LRYGBs were performed. The patient population was 85 per cent women with a mean body mass index (BMI) of 50.4 kg/m2 (range 33–96 kg/m2). The mean age was 44 (range 15–67). Sixty-two per cent of the patients had previous abdominal or pelvic operations. The conversion rate to open surgery was 0.2 per cent. The average length of hospital stay was 2.6 days (range 2–13 days). There were no anastomotic leaks or deaths. The 30-day readmission and re-operation rates were 3.2 per cent and 1.8 per cent, respectively. The incidence of anastomotic stricture, marginal ulcer, bleeding, pulmonary embolism, and internal hernia was 0.8 per cent, 3.5 per cent, 4.2 per cent, 0.1 per cent, and 0.4 per cent, respectively. A systematic and evidence-based approach to the LRYGB by experienced laparoscopic surgeons resulted in a lower incidence of complications when compared with the published results from other comparable institutions.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

scholarly journals Why do frail patients with chronic heart failure die and become hospitalised?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Sze ◽  
P Pellicori ◽  
J Zhang ◽  
J Weston ◽  
A.L Clark
Keyword(s):  
Heart Failure ◽  
Cause Of Death ◽  
Hospital Admissions ◽  
Average Length ◽  
Significant Proportion ◽  
Length Of Hospital Stay ◽  
Clinical Frailty Scale ◽  
Frail Patients ◽  
Increased Risk

Abstract Background Frailty is common in patients with heart failure (HF) and is associated with increased morbidity and mortality. A better understanding of the causes of hospitalisations and death in frail patients might help to tailor interventional strategies for these at-risk patients. Purpose We studied the cause of death and hospitalisations in ambulatory patients with HF and frailty. Methods We assessed frailty using the clinical frailty scale (CFS) in consecutive HF patients attending a routine follow-up visit. Those with CFS ≥5 were classified as frail. Mortality and hospitalisations were ascertained from medical records (updated systematically using an NHS electronic database), discharge letters, autopsy reports and death certificates. We studied the primary cause of death and hospitalisations within one year of enrolment. Results 467 patients (67% male, median (IQR) age 76 (69–82) years, median (IQR) NT-proBNP 1156 (469–2463) ng/L) were enrolled. 206 (44%) patients were frail. Frail patients were more likely to not receive or receive suboptimal doses of ACEi/ARB and Beta-blockers; while non-frail patients were more likely to be treated with optimal doses. At 1-year follow up, there were 56 deaths and 322 hospitalisations, of which 46 (82%) and 215 (67%) occurred in frail patients. Frailty was associated with an increased risk of all-cause mortality (HR (95% CI): 4.27 (2.60–7.01)) and combined mortality/ hospitalisation (HR (95% CI): 2.85 (2.14–3.80)), all p<0.001. 57% (n=26) of frail patients died of cardiovascular causes (of which 58% were due to HF progression); although deaths due to non-cardiovascular causes (43%, n=20), especially severe infections, were also common (26%, n=12). (Figure 1) The proportion of frail patients who had non-elective hospital admissions within 1 year was more than double that of non-frail patients (46% (n=96) vs 21% (n=54); p<0.001). Compared to non-frail patients, frail patients had more recurrent (≥2) hospitalisations (28% (n=59) vs 9% (n=24); p<0.001) but median (IQR) average length of hospital stay was not significantly different (frail: 6 (4–11) vs non-frail: 6 (2–12) days, p=0.50). A large proportion of hospitalisations (64%, n=137) in frail patients were due to non-cardiovascular causes (of which 34%, 30% and 20% were due to infections, falls and comorbidities respectively). Of cardiovascular hospitalisations (36%, n=78), the majority were due to decompensated HF (67%, n=46). (Figure 1) Conclusion Frailty is common in patients with HF and is associated with an increased risk of mortality and recurrent hospitalisations. A significant proportion suffered non-cardiovascular deaths and hospitalisations. This implies that interventions targeted at HF alone can only have limited impact on outcomes in frail patients. Figure 1 Funding Acknowledgement Type of funding source: None

Pre-thrombectomy intravenous thrombolytics are associated with increased hospital bills without improved outcomes compared with mechanical thrombectomy alone

2019 ◽  
Vol 11 (12) ◽  
pp. 1187-1190 ◽  
Author(s):  
Ameer E Hassan ◽  
Hari Kotta ◽  
Leeroy Garza ◽  
Laurie Preston ◽  
Wondwossen Tekle ◽  
...  
Keyword(s):  
Average Length ◽  
Length Of Hospital Stay ◽  
Functional Independence ◽  
Multivariate Statistical ◽  
Capture Process ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Intravenous Tissue Plasminogen Activator ◽  
Improved Outcomes ◽  
Iv Tpa

ObjectiveTo investigate whether significant differences exist in hospital bills and patient outcomes between patients who undergo endovascular thrombectomy (EVT) alone and those who undergo EVT with pretreatment intravenous tissue plasminogen activator (IV tPA).MethodsWe retrospectively grouped patients in an EVT database into those who underwent EVT alone and those who underwent EVT with pretreatment IV tPA (EVT+IV tPA). Hospital encounter charges (obtained via the hospital’s charge capture process), final patient bills (ie, negotiated final bills as per insurance/Medicare rates), demographic information, existing comorbidities, admission and discharge National Institutes of Health Stroke Scale (NIHSS) score, and functional independence data (modified Rankin Scale score 0–2) were collected. Univariate and multivariate statistical analyses were performed.ResultsOf a total of 254 patients, 96 (37.8%) underwent EVT+IV tPA. Median NIHSS score at admission was significantly higher in the EVT+IV tPA group than in the EVT group (p=0.006). After adjusting for NIHSS admission score, patient bills and encounter charges in the EVT+IV tPA group were still found to be $3861.64 (95% CI $658.84 to $7064.45, p=0.02) and $158 071.29 (95% CI $134 641.50 to $181 501.08, p < 0.001) greater than in the EVT only group respectively. The EVT+IV tPA group had a higher complication rate of intracranial hemorrhage (ICH) (p=0.005). The EVT and EVT+IV tPA groups did not differ significantly in median discharge NIHSS score (p=0.56), functional independence rate at 90 days (p=0.96), or average length of hospital stay (p=0.21).ConclusionPatients treated with EVT+IV tPA have greater hospital encounter charges and final hospital bills as well as higher rates of ICH than patients who undergo treatment with EVT only.

Doppler-Guided Hemorrhoidal Artery Ligation: Experience with 2 Years Follow-up

2012 ◽  
Vol 78 (3) ◽  
pp. 344-348 ◽  
Author(s):  
İbrahim Yilmaz ◽  
İlker Sücüllü ◽  
Dursun Özgür Karakaş ◽  
Yavuz Özdemİr ◽  
Ergün Yücel ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Artery Ligation ◽  
Superior Rectal Artery ◽  
Quick Recovery ◽  
Doppler Probe ◽  
Hemorrhoidal Artery Ligation ◽  
Hemorrhoidal Artery

Doppler-guided hemorrhoidal artery ligation (DGHAL) is a nonexcisional surgical technique for the treatment of hemorrhoidal disease, consisting of the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of hemorrhoidal plexus resulting in fibrosis. The aim of the study was to assess the efficacy and safety of DGHAL, define its indications, and identify its possible advantages and limitations for the treatment of second- and third-degree hemorrhoids. The procedure was performed using a specially designed proctoscope. The Doppler probe was used to locate all the terminal branches of hemorrhoidal arteries, which were then sutured. Patients were followed up for 2 years. From November 2006 to May 2009, 50 patients (29 female, mean age 38.2 years) underwent this procedure. The procedure was performed under local anesthesia. An average of five ligatures was placed. Average length of hospital stay was 2 hours and return to work was 2.5 days. The mean postoperative pain score was 1.72. There were no intra- or immediate postoperative major complications. In 44 patients (88%), surgery resolved the symptoms completely in a 2-year follow-up period. DGHAL is a safe and effective procedure. DGHAL can be the choice for second- and third-degree hemorrhoids with minimal postoperative pain and quick recovery.

scholarly journals Involuntary out-patient commitment: 2-year follow-up

2013 ◽  
Vol 37 (2) ◽  
pp. 60-64 ◽  
Author(s):  
Laura Castells-Aulet ◽  
Miguel Hernández-Viadel ◽  
Pedro Asensio-Pascual ◽  
Carlos Cañete-Nicolás ◽  
Carmen Bellido-Rodríguez ◽  
...  
Keyword(s):  
Mental Disorder ◽  
Emergency Room ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Delusional Disorder ◽  
Emergency Room Visits ◽  
Court Order ◽  
Severe Mental Disorder ◽  
The Impact

Aims and methodTo evaluate the impact of involuntary out-patient commitment (OPC) in patients with severe mental disorder who use hospital services. This is a retrospective–observational study in a population of 91 patients under OPC. The psychiatric diagnosis, sociodemographic variables, who requested the court order and for what motive were studied. The study also looked at the use of the available health services (emergency room visits, admissions, average length of hospital stay) for the period beginning 2 years before and ending 2 years after the initiation of the OPC.ResultsThe number of emergency room visits, admissions and the length of hospitalisation diminished in the 2 years following the initiation of the OPC. In terms of diagnosis, the OPC has the most impact on individuals with schizophrenia and delusional disorder.Clinical implicationsThe OPC can be useful for certain patients with severe mental disorder, particularly individuals with schizophrenia and delusional disorder.

scholarly journals A 5-Year Experience of a Minimally Invasive Technique for Correction of Pectus Excavatum in Croatia

2006 ◽  
Vol 49 (2) ◽  
pp. 105-107 ◽  
Author(s):  
Mirko Žganjer ◽  
Božidar Župančić ◽  
Ljiljana Popović
Keyword(s):  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Minimally Invasive Operation ◽  
Steel Bar ◽  
Normal Chest

The aim of this study was to assess the results of 5-year experience with minimally invasive operation without medial incision and resection cartilages for correction of pectum excavatum. From 2000 we made in our Hospital minimally invasive technique for the correction of pectus excavatum. 75 patients were treated by minimally invasive technique. A convex steel bar is inserted under the sternumtrough small bilateral Incisions. The steel bar is inserted with the convexity facing posteriorly, and when it is in position, the bar is turned over. After 2 years the bar is removed when permanent remolding has occurred. Initial excelent results were maintained in 54 patients (normal chest), good results in 16 (mild residual pectus) and poor in 5 (severe recurrence requiring further treatment). The mean follow-up since surgery were 3 months to 3 years. Average blood loss was 25 ml. Average length of hospital stay was 8 days. Patients returned to full activity after 2 month. Complications were pneumothorax in 12 patients, pneumonia in 6 patients and displacement of the steel barr requiring revision in 2 patients. Poor results occurred because steel bar was too soft in 3 patients, and soft sternum in 2 patients with Marfan’s syndrome. The minimally invesive technique is effective without cartilage incision and resection or sternal osteotomy.

scholarly journals Treatment of Cavitary Bone Defects in Chronic Osteomyelitis: Bioactive glass S53P4 vs. Calcium Sulphate Antibiotic Beads

2017 ◽  
Vol 2 (4) ◽  
pp. 194-201 ◽  
Author(s):  
Albert Ferrando ◽  
Joan Part ◽  
Jose Baeza
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Chronic Osteomyelitis ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Calcium Sulphate ◽  
Bone Defects ◽  
Group 2 ◽  
Group 1

Abstract. Aim: To evaluate the efficacy of bioglass (BAG-S53P4) in the treatment of patients with chronic osteomyelitis and compare the results with calcium sulphate antibiotic beads in one medical centre.Methods: Retrospective analysis of 25 cases. Inclusion criteria: patients diagnosed clinically and radiographically of osteomyelitis and treated surgically (Group 1: cavitary bone defects treated with bioglass and Group 2: cavitary bone defects treated with calcium sulphate antibiotic beads) during the period of 2014 and 2015 in one medical centre.Results: Patients in group 1 (bioglass treatment): total of 12 patients (11 males and 1 female) with mean age: 50 years (30-86). Average length of hospital stay was 22 days and mean follow-up time: 23 months (16-33). Mean erythrocyte sedimentation rate (ESR) and mean c-reactive protein (CRP) before surgery: 55mm/hr and 54 mg/L, respectively. Mean ESR and mean CRP in last blood exam: 18 mm/hr and 8 mg/L, respectively. There were 2 postoperative complications: seroma formation and delayed wound healing. Only 1 patient had recurrence of infection.Patients in group 2 (calcium sulphate antibiotic beads treatment): total of 13 patients (9 males and 4 females) with mean age: 48 years (17-67). Average length of hospital stay was 21 days and mean follow-up time 22 months (16-29). Mean ESR and mean CRP before surgery: 51mm/hr and 41 mg/L, respectively. Mean ESR and mean CRP in last blood test: 15 mm/hr and 11 mg/L. 2 postoperative complications were registered: chronic expanding hematoma of the muscle flap donor site and seroma formation. 1 patient had recurrence of infection. Overall, there were no differences in recurrence of infection, p=0.740 and in complication rate, p=0.672. 11 (91,7%) patients in group 1 and 12 (92,3%) patients in group 2 showed no signs of recurrence of infection both clinically and radiologically at final follow-up.The most frequent cause of osteomyelitis in group 1 was post traumatic while a postsurgical aetiology was more frequent in group 2. The distal tibia was the most common location. The most frequent pathogen isolated in both groups was methicillin sensible staphylococcus aureus.Conclusions: An advance in treatment of patients with cavitary bone defects in chronic osteomyelitis is the use of synthetic bone substitutes although current evidence is low. In this study, we demonstrate how bioglass without local antibiotics and calcium sulphate antibiotic beads are both equally effective treatment options. Overall, there were no differences between groups in mean hospital stay, complication rates and recurrence of infection.

The Mortality of Vancomycin-Resistant Enterococci Bloodstream Infections (VRE BSI)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4928-4928 ◽  
Author(s):  
Philip Young-Ill Choi ◽  
Belinda Straube ◽  
Christine Cook ◽  
Carrie Van Der Weyden ◽  
Sundra Ramanathan ◽  
...  
Keyword(s):  
Progressive Disease ◽  
Antimicrobial Agents ◽  
Conflicts Of Interest ◽  
Average Length ◽  
Improve Patient Safety ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Contact Tracing ◽  
Disease Stage

Abstract Abstract 4928 Background VRE are nosocomial pathogens with resistance to most commonly used antimicrobial agents. VRE BSI occurs in as few as 4% of patients colonised with VRE[i]. A review of factors contributing to the development of VRE BSI was performed to improve patient safety at St George Hospital. Alarmingly, there were 9 new cases of VRE BSI detected amongst haematology inpatients in early 2010, as compared with only 2 in the previous 6 months. In high risk populations, the rate of VRE BSI amongst patients colonised with VRE can be as high as 29%[ii]. VRE BSI is associated with an increased length of hospital stay from 10.5 to 46 days[iii][iv]and an estimated increased cost of $27,190 per patient[v]. Annual net savings of $100,000-150,000 can be achieved by hospitals detecting 6–9 cases of VRE BSI per year by utilising enhanced infection control strategies[vi]. Methods Admission details for haematology in-patients and their microbiology results between 1/6/2009-30/11/2010 were reviewed. A subsequent case-controlled analysis was performed matching for patient age, disease and disease stage. Interventions to reduce the rate of VRE transmission were introduced in July 2010: improved hand hygiene education, additional staffing allocations, additional cleaning services, antimicrobial stewardship, improved patient education, increased staff awareness, monthly census screening of all patients on the 4 East Oncology/Haematology ward for VRE and contact tracing measures. Results 471 patients were admitted a total of 943 times. VRE was isolated in 61 patients. Average length of stay was significantly longer in patients with VRE than for patients without VRE [16.3±3.0 vs 8.4±1.0 days, p=0.01]. 16 patients had VRE BSI. After a median follow-up of 9.8 months, eight of these patients have died (50% mortality), mostly due to progressive disease. 45 patients had non-BSI VRE and were followed up for a median 8.4 months: 24 died (53% mortality), also mostly due to progressive disease. Case-controlled Analysis An age, case and stage of disease matched analysis compared 14 patients with VRE and 14 with no evidence of VRE. Median follow-up from presentation with disease was 16.3 months and from VRE detection was 8 months. Mortality rate was 64% vs 29%. Seven out of nine deaths in the VRE cohort were due to progressive disease. Conclusions The clinical significance of VRE BSI over other modes of detection remains uncertain for individual patients, however high rates may reflect uncontrolled VRE transmission. Case controlled analysis demonstrates an associated additional mortality risk for VRE positive patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Outcomes of Extravesical Versus Intravesical Ureteral Reimplantation

2004 ◽  
Vol 4 ◽  
pp. 195-197
Author(s):  
Leah P. McMann ◽  
Byron D. Joyner
Keyword(s):  
Length Of Stay ◽  
Vesicoureteral Reflux ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Renal Ultrasound ◽  
Voiding Cystourethrogram ◽  
Ureteral Reimplantation ◽  
Success Rates ◽  
Average Length Of Stay

Purpose: The purpose of our study was to examine outcomes and compare length of stay after extravesical and intravesical ureteral reimplantation at our institution. Materials and Methods: Retrospective review was performed of 30 patients (55 ureters) with vesicoureteral reflux who underwent either the Cohen (intravesical) cross-trigonal procedure or the extravesical (detrusorrhaphy) approach. Each patient had documented follow-up consisting of a postoperative renal ultrasound and/or a voiding cystourethrogram (VCUG). Inclusion criteria was the presence of primary vesicoureteral reflux. Exclusion criteria were patients who had undergone a previous repair and patients in whom results of neither the renal ultrasound nor the VCUG were available. Results: There were no significant cases of obstruction or wound infection with either approach. Two patients who underwent the extravesical approach had persistent reflux on VCUG three months postoperatively, but both resolved by fifteen months. Average length of stay was only 3.00 ± 1.33 days for the extravesical approach, compared to 5.36 ± 1.75 days for the intravesical approach ( P = .0003 ). Conclusions: Given that by fifteen months success rates were the same with either approach, the extravesical approach is comparable to the intravesical technique and is a viable option in terms of outcome and economics given the shorter length of hospital stay.

Effectiveness of Thoracoscopic Truncal Vagotomy in the Treatment of Marginal Ulcers after Laparoscopic Roux-en-Y Gastric Bypass

2012 ◽  
Vol 78 (6) ◽  
pp. 663-668 ◽  
Author(s):  
John Hunter ◽  
Richard D. Stahl ◽  
Manasi Kakade ◽  
Igal Breitman ◽  
Jayleen Grams ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Chart Review ◽  
Operative Time ◽  
Telephone Interview ◽  
Marginal Ulcer ◽  
Symptomatic Improvement ◽  
Truncal Vagotomy ◽  
Peptic Ulcers ◽  
Median Operative Time

Marginal ulcer is a significant complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). Most marginal ulcers resolve with medical management, but nonhealing ulcers may require revision of the gastrojejunostomy, a procedure with significant morbidity and mortality. Traditionally, surgical therapy for refractory peptic ulcers includes a vagotomy. The current study evaluates the effectiveness of thoracoscopic truncal vagotomy (TTV) in the management of refractory marginal ulcers. All patients at two institutions with an intractable marginal ulcer after LRYGB treated with TTV between 2003 and 2010 were reviewed. Data were collected from chart review and telephone interview. Seventeen patients (mean age, 39 ± 13 years; 16 females) were diagnosed with marginal ulceration a median of 18 months after LRYGB and proceeded to TTV at a mean of 39 ± 43 weeks (range, 1 to 114 weeks) after the diagnosis. The median operative time was 89 ± 65 minutes (range, 45 to 318 minutes). Four patients had a complication (sympathetic contralateral pleural effusion, pneumothorax, operative bleeding, and readmission for emesis). Eleven patients had follow-up of 3 months to 6 years (median, 7 months). Nine patients (82%) had symptomatic improvement and/or endoscopic resolution, whereas two (18%) did not. No patient had endoscopic evidence of persistent or recurrent marginal ulcer. TTV achieves symptomatic improvement and/or endoscopic resolution of intractable marginal ulcers in over 80 per cent of patients status post gastric bypass and therefore offers a less morbid alternative to revision of the gastrojejunostomy.

Sign in / Sign up

Export Citation Format

Share Document